BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CAPTURE LP

    MDR report key: 7066888 · Received November 29, 2017

    Report

    Report Number
    7066888
    Event Type
    Malfunction
    Date Received
    November 29, 2017
    Date of Event
    October 9, 2017
    Report Date
    November 10, 2017
    Manufacturer
    MICRO THERAPEUTICS, INC.
    Product Code
    NRY
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE DEVICE BROKE INSIDE THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    847180 CAPTURE LP CATHETER, THROMBUS RETRIEVER NRY MICRO THERAPEUTICS, INC. A505911

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR NOT KNOWN.